Narcissistic Personality Disorder: What You Should Know

These days, it's common for people to toss the term "narcissist" around when referring to someone they may not get along with. That generally comes with an understanding that the person in question is self-centered and lacks regard for others.

Despite the frequent use of that term, the psychological disorder of narcissistic personality disorder (NPD) is widely misunderstood. Common misconceptions about it can interfere with a person's ability to identify it in themselves or others and get the treatment they need to better deal with the condition.

Learn more about what narcissistic personality disorder is, what might cause it, how it is treated, and more below. 

What is narcissism?

The term "narcissism" is usually used to describe a person or set of behaviors that are self-absorbed, vain, and in constant need of validation while also having difficulties truly connecting to others. Anyone can show narcissistic behavior at times, but a persistent display of narcissistic behavior may be defined as narcissism. 

Narcissism is a trait that exists on a spectrum, while narcissistic personality disorder is a psychological condition. Those who are considered narcissists may also have traits of NPD, but they may not have severe enough symptoms to warrant an official NPD diagnosis. 

There are two types of narcissism — vulnerable narcissism and grandiose narcissism. Vulnerable narcissism appears in people who generally have low self-esteem and intense sensitivity to criticism of any kind, despite what they may show to the outside world. On the other hand, grandiose narcissism is characterized by extremely high self-esteem and self-importance, and those with grandiose narcissism tend to report higher levels of life satisfaction. 

Signs and symptoms of narcissism

Not every person with narcissism or NPD displays the same traits, but there are some common characteristics among those experiencing narcissism, such as:

• Having a constant need for validation or admiration from others

• Feeling entitled to more than the average person

• Taking advantage of other people for personal gain

• Displaying arrogance regularly

• Envisioning fantasies of success and power regularly

• Having an excessive sense of self-importance

• Lacking a sense of empathy for others

• Having an inability to recognize others' feelings or needs

• Exaggerating abilities, talents, or possessions

While the above signs and symptoms typically culminate in a person that tries to appear superior to other people in many ways, the person suffering from narcissism usually has trouble maintaining quality relationships and feeling genuinely connected to others. This may be because they struggle to feel empathy and understand how their actions or words can negatively impact others.

People with narcissism may also have difficulty maintaining relationships because they often hold others to impossibly high standards. As a result, it is common for those with narcissism to cut off relationships due to insignificant or perceived issues with the other person and hold their position long-term. 

Causes and risk factors of narcissism

Currently, there is no known cause of narcissism or narcissistic personality disorder, but experts believe that a combination  of the following factors may increase the odds of an NPD diagnosis:

• Having a family history of NPD

• Experiencing abuse and trauma in early childhood

• Having certain innate personality and temperament characteristics

• Having a hypersensitivity to light, sounds, or textures as a child

• Receiving excessive judgment or praise from caretakers or other adults as a child

Just because a person has one or several risk factors doesn't necessarily mean that they will display narcissism or develop NPD, but they may have an increased risk. If you have the above risk factors and are worried about developing narcissism, it can be helpful to speak with a mental health professional. 

How is narcissism diagnosed?

A psychologist or psychiatrist usually diagnoses narcissism. These mental health professionals specialize in psychological conditions, and they will meet with an individual to learn more about their lifestyles, relationships, other physical or mental conditions, and more. 

Psychologists and psychiatrists will also often use evaluations and questionnaires to determine whether narcissism or NPD is an appropriate diagnosis. Individuals who display narcissistic traits can be diagnosed after talking to a mental health professional about struggles with maintaining relationships, behavior and thought patterns, and how the person interacts with others regularly. 

Many psychotherapists use standardized personality tests to better understand how you feel and view the world, which can help them rule out other conditions and get closer to a proper diagnosis. Some of the most commonly used personality tests include:

• International personality disorder examination (IPDE)

• Personality diagnostic questionnaire-4 (PDQ-4)

• Millon clinical multiaxial inventory III (MCMI-III)

When taking these tests, the individual needs to answer the questions as honestly as possible. Though it can be embarrassing to admit thinking or feeling certain ways, honesty is the only way to address the problem. 

When is narcissism a personality disorder?

Narcissism can become a personality disorder when the symptoms become more persistent and severe, to the point where it is difficult to live, work, and socialize normally. Personality disorders also tend to be developed in a person's late teens or early 20s, though teenagers may exhibit self-absorbed behavior, which they will grow out of. 

Many people are diagnosed with NPD during this stage of life, but many people with NPD go undiagnosed for many years or even their entire lives. 

Remember that narcissism is a spectrum, and almost everybody exhibits narcissistic behavior at some point and time. Narcissism, however, becomes a personality disorder when narcissistic behavior and thinking creep into every aspect of life, from education and work to friendships and romantic relationships. 

People who are unable or unwilling to acknowledge others' feelings or needs and those willing to take advantage of others may be on the farther end of the narcissism spectrum into NPD. 

Narcissism becomes a diagnosable disorder when a person exhibits five or more of the traits listed under the "signs and symptoms of narcissism" header, per the DSM-5. Psychotherapy and other treatments can change such thoughts and behaviors to better manage the condition and improve relationships and life satisfaction. 

Do narcissists know that they are narcissists?

Many people with narcissism may feel different from their peers, especially when they can't connect with people like they may want to. Sadly, NPD and narcissism make it difficult to acknowledge¹ that a problem may lie within themselves instead of everyone else as they may typically perceive. 

Interestingly, some research shows that those with narcissism tend to possess some awareness² that their image of themselves is more positive than how others may view them. They often understand that they are better at first impressions than maintaining relationships in the long term. 

Even with these hints of awareness, most people with narcissism would not describe themselves as narcissists. 

Narcissism treatment

Narcissism treatment can be challenging as it can take time to confirm the diagnosis. Once a diagnosis is confirmed, someone can commence treatment. Treatment can help the person address their narcissistic traits and better connect with others.

The primary treatment for narcissism and NPD is long-term counseling and therapy.

Therapists typically work with these individuals to develop a healthy sense of confidence. Counseling also usually focuses on acknowledging the feelings and needs of others to foster a greater sense of empathy, allowing the person with NPD to better connect with others. 

Because many people with narcissism also struggle with depression and anxiety, physical health issues, and substance abuse, other modes of treatment may also become necessary to help address other points of distress that may further exacerbate their narcissistic traits. Treating anxiety and depression with medications may also help improve some individuals' symptoms. 

Living with narcissism

NPD and narcissism can make it harder for people to connect with each other on a daily basis, and narcissism can be just as hard for those suffering from it as it is for those around them. There are some ways that both parties can work toward improving the symptoms of narcissism and NPD, but it takes a long-term commitment³ from the person with narcissism and their loved ones to live a truly meaningful and connected life with the condition. 

If you have narcissism

If you feel that you may be struggling with narcissism, it can be helpful to set up an appointment with a psychologist to undergo testing and evaluations. From there, a psychologist can help you devise a comprehensive treatment plan to change behaviors for a richer, more fulfilling life. 

Even if you don't have narcissism, seeing a mental healthcare practitioner can help you explore the negative feelings you are experiencing and devise a strategy to help you make better connections with others. 

If a loved one has narcissism

If a loved one struggles with narcissism, it can be difficult to maintain a healthy relationship and provide the support they need. People with narcissism tend to push people away if they perceive another person is making a mistake or wronging them, and they may cut you out of their life for seemingly no reason.

If you are in a relationship with someone struggling with narcissism, it may be helpful to have the number of an abuse hotline or a support group on hand just in case you need additional support.

If your partner struggles with narcissism, couple's therapy can help both you and your loved one better manage their symptoms and work toward a healthier, happier partnership. When both partners agree to attend therapy, the chances of building a better life together tend to increase. 

When should you visit a doctor?

It can be helpful for people who believe they may have NPD or narcissism to visit a doctor for a referral to a mental health professional, especially if they also have become dependent upon alcohol and other substances or experience suicidal thoughts or behavior. 

Unfortunately, it is common for people with NPD not to believe that anything is wrong in their life or relationships, so they may be unlikely to seek treatment. It's also difficult for others to recommend seeking treatment. This can be perceived as a criticism or insult, making a person with NPD more likely to cut themselves off or withdraw socially. 

It's a good idea to visit a doctor or mental health professional if you struggle to connect with others, maintain relationships, and experience several of the symptoms listed above. You can visit your primary care physician for an initial consultation, and they may refer you to a psychologist or a psychiatrist for further evaluation and treatment.

It can be hard to seek treatment for any condition or disorder, but getting the treatment you need if you suffer from narcissism or NPD can help you engage in better behavior.

The lowdown

Narcissism and NPD can make everyday life and maintaining relationships difficult for those suffering from the condition and the people surrounding them. It's also a challenging condition to diagnose and treat, as the person with the condition may struggle to accept that there is a problem at hand. 

Fortunately, those who seek treatment and stick with it in the long term can change their behaviors to forge better relationships, exhibit more empathy, and live an overall better and more fulfilling life.